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Macrocytosis is a condition where red blood cells are larger than normal. [1] These enlarged cells, also known as macrocytes, are defined by a mean corpuscular volume (MCV) that exceeds the upper reference range established by the laboratory and hematology analyzer (usually >110 fL). [2]
Macrocytic anemias have several causes but with the implementation of folic acid fortification in North America, folate deficiency has become a rare cause of megaloblastic macrocytic anemia in that part of the world. [1] In this region, Vitamin B 12 deficiency is a far more common cause of megaloblastic macrocytic anemia. [1]
The mean corpuscular volume, or mean cell volume (MCV), is a measure of the average volume of a red blood corpuscle (or red blood cell). The measure is obtained by multiplying a volume of blood by the proportion of blood that is cellular (the hematocrit), and dividing that product by the number of erythrocytes (red blood cells) in that volume.
The normal mean corpuscular volume (abbreviated to MCV on full blood count results, and also known as mean cell volume) is approximately 80–100 fL. When the MCV is <80 fL, the red cells are described as microcytic and when >100 fL, macrocytic (the latter occurs in macrocytic anemia). The MCV is the average red blood cell size.
Folate and vitamin B 12 deficiency anemia usually presents with high RDW and high MCV. Mixed-deficiency (iron + B 12 or folate) anemia usually presents with high RDW and variable MCV. Recent hemorrhages typically present with high RDW and normal MCV. A false high RDW reading can occur if EDTA anticoagulated blood is used instead of citrated blood.
This phenomenon causes red blood cells to clump together because of antibodies bound to the cell surface. [196] Red blood cell aggregates are counted as single cells by the analyzer, leading to a markedly decreased red blood cell count and hematocrit, and markedly elevated MCV and MCHC (mean corpuscular hemoglobin concentration). [53]
Megaloblastic anemia is a type of macrocytic anemia.An anemia is a red blood cell defect that can lead to an undersupply of oxygen. [1] Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. [2]
A diagnosis of PA first requires demonstration of megaloblastic anemia by conducting a full blood count and blood smear, which evaluates the mean corpuscular volume (MCV), as well the mean corpuscular hemoglobin concentration (MCHC). [50] PA is identified with a high MCV (macrocytic anemia) and a normal MCHC (normochromic anemia). [54]